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Organization
YOUTH OPPORTUNITIES
Active
Organization
YOUTH OPPORTUNITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANUEL MARIANO GOMEZ (V.P. FINANCE AND BUSINESS)
(336) 724-1412
Entity
Organization
Contact information
Practice address
810 BAGLEY ROAD, KERNERSVILLE, NC 27284-9897
(336) 724-1412
(336) 724-1464
Mailing address
7670 NORTHPOINT CT., WISNTON-SALEM, NC 27106-3336
(336) 724-1412
(336) 724-1464
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8303449R
—
NC
Enumeration date
12/16/2010
Last updated
05/16/2012
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